Target Audience

Health care professionals involved with rheumatological care in the state of Iowa and the Midwest.

Educational Need

The relationship between rheumatic disease and cancer has been increasingly appreciated. Rheumatologists need to be knowledgeable about which patients with rheumatic diseases are at highest risk for cancer to inform their clinical management and screening practices. They also should be able to identify clinical syndromes that are classically paraneoplastic.

Immune checkpoint inhibitors are an increasingly used type of cancer immunotherapy. These drugs work by blocking negative T cell costimulation, thus leading to generalized activation. As a result of their non-specific mechanism, immune checkpoint inhibitors can lead to immune related adverse events (irAEs). Some irAEs resemble traditional rheumatic diseases. As immune checkpoint inhibitor use grows, it is important for rheumatologists to be able to identify and treat rheumatic irAEs. Rheumatologists will also be asked to monitor and treat patients with preexisting autoimmune disease who undergo immune checkpoint inhibitor therapy for cancer.

Today’s challenging health care environment is affecting the way physicians manage their practices, interfering with access to care and forcing them to make difficult decisions. Physicians seek to continue to provide quality care while contending with reduced Medicare reimbursement rates, medical claims, process errors and inefficiency, and legislative and regulatory changes. Rheumatologists need to be aware of emerging trends in practice management, payer reform, and administrative simplification of impact to the success of their practices and quality of patient care.

Rheumatologists and their patients will be significantly impacted by the implementation of MACRA, thus education and training on the resultant programs are important to ensure practice viability and compliance with the new requirements. Absent such education, rheumatology practices are more likely to absorb steep financial penalties and fail to comply with new statutory and regulatory mandates, which could subsequently result in the closure of rheumatology practices and loss of beneficiary access to important rheumatology care.

Pharmacy benefit management systems have been accused of raising costs to patients through complex rebate programs. Rheumatologists prescribe expensive medications subject to these program and so need to understand how they operate.

Objectives

1. Identify subgroups of patients with rheumatic disease at highest risk for cancer.
2. Describe clinical manifestations of paraneoplastic rheumatic syndromes.
3. Discuss cancer screening in patients with suspected paraneoplastic rheumatic disease.
4. Describe the mechanism of action of immune checkpoint inhibitors.
5. Identify rheumatic immune related adverse events (irAEs) that occur from immune checkpoint inhibitors.
6. Describe treatment options for rheumatic irAEs.
7. Discuss the use of immune checkpoint inhibitors in those with preexisting autoimmune disease.
8. Identify federal efforts to improve value in healthcare delivery and payment through programs established under the Medicare Access and CHIP Reauthorization Act (MACRA).
9. Distinguish and contrast pathways for Rheumatologists to be reimbursed under the Quality Payment Program (i.e., the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).
10. Evaluate the potential impact of MACRA on Rheumatology practices and estimate the significance of engagement in current and future value driven delivery and payment models.
11. Explain legislative trends regarding practice management, payer reform, and medication access of impact to the medical community and rheumatologists throughout the country and related proposals in Iowa.
12. Identify opportunities for state and national advocacy, legislative action and our need for representation at the state national level.
13. Explain the function of drug rebates in the health insurance system and the impact on costs for patients.
14. Recognize the interaction between insurance, pharmaceutical buying organizations and prescription drug cost as well as the effect of these on patient care.

Registration/Information Desk Hours 

• Friday, February 23, 2018 from 3:00 p.m. – 7:00 p.m.
• Saturday, February 24, 2018 from 7:30 a.m. – 4:00 p.m.

Exhibit Hall Hours

• Friday, February 23, 2018 from 4:30 p.m. – 7:00 p.m.
• Saturday, February 24, 2018 from 8:00 a.m. – 3:00 p.m.

Agenda

All sessions will be located in the Amphitheater unless otherwise noted. Speakers and times are subject to change.

Speaker BioSketches

Pam Jochum, Iowa State Senator

Born and raised in Dubuque, Senator Jochum knows what matters to those who live and work in the area. Elected to Iowa House in 1992 and then to the Iowa Senate in 2008, she is respected for her ability to build coalitions that get things done for Dubuque and Iowa. Senator Jochum is ranking member on the Ways & Means Committee and on the Administrative Rules Review Committee. She also serves on the Ethics, Human Resources, State Government and Rules & Administration committees.

Senator Jochum’s priorities include health care, education, tax policies and oversight of the Governor’s rule-making authority. She works hard to ensure the balance of power between the Legislative and Executive branches of government. Among her many accomplishments, Senator Jochum has played a leading role in expanding affordable health insurance coverage to thousands of working Iowans and has stood up for citizens with disabilities to protect their health services when the Governor privatized Iowa’s Medicaid system. Her support for and commitment to education has been unwavering. She has worked to expand early childhood education and ensure affordable higher education, whether at a state university, a private college or a community college. Her influence is evident throughout Iowa law— from historic reforms in Iowa’s commercial property taxes and revitalizing manufacturing to nationally acclaimed legislation in ethanol production, wind energy, solar energy and flood mitigation programs. Furthermore, through Pam’s persistent work for more than five years, our state now has the Iowa Public Information Board to ensure government transparency and access to public information and records.

Senator Jochum learned the value of a hard-day’s work from her parents. She graduated at the top of her class at Wahlert High School and Loras College. She worked as an administrator at Loras College, and also worked at an insurance agency, Legal Aid, and a financial services company before running for public office. 

Senator Jochum believes creating an economy that works for all Iowans is vital to Iowa’s future. That means living wage jobs, topnotch education, quality child care, affordable health care,a tax system in which all pay their fair share, and a fiscally responsible budget that meets the needs of citizens. She also understands the role that our environment plays in the health and economic success of our state and nation.

Because of her strong advocacy and efforts to improve the lives of Iowans, Senator Jochum has received honors from the League of Cities, Firefighters Association, child advocacy organizations, Freedom of Information Council, physical therapists, physician assistants, Iowa Hospital Association, Iowa Caregivers, Iowa Health Care Association, League of Women Voters, the Dubuque Chamber of Commerce, labor unions, Girl Scouts of Eastern Iowa and many more.

Liz Mathis, Iowa State Senator 

Liz Mathis is an Iowa State Senator and Community Engagement Project Manager for Four Oaks, the Affordable
Housing Network and Jane Boyd Community House. Senator Mathis is one of 50 State Senators in Iowa; District 34 includes metro and rural Linn County. She is an Assistant Minority Leader and serves on the Human Resources, Commerce and Appropriations committees and is a ranking member of the Administration and Regulation subcommittee.

In her role with Four Oaks, Senator Mathis works with other agency administrators on special projects for one of the state’s largest children’s mental and behavioral health agencies. Four Oaks and its affiliates have 16 Iowa program sites, and more than 1000 staff. Her prior work experience includes 27 years as a broadcast journalist and as a professor at Wartburg College, where she led the Department of Communication Arts as the McElroy Chair.

Senator Mathis has received professional leadership and legislative awards, including her induction as an Alumni Fellow at the University of Iowa College of Liberal Arts and Sciences and as a Corridor Business Journal’s “Woman of Influence” and one of the “Most Influential.” She is a Director for Ohnward Bank, serves on the Wartburg College Board of Regents, Marion Cares Advisory Board and the University of Iowa School of Journalism Professional Advisory Board. She holds a BA in Journalism and Broadcasting & Film from the University of Iowa.

Senator Mathis and her husband Mark have two children. Mark owns Amperage Marketing with offices in Cedar Falls, Cedar Rapids and Des Moines.

Michael S. Brooks, MD, FACP, FACR, RAI President

Dr. Brooks graduated from Loyola University, Stitch School of Medicine in Maywood, Illinois and continued on to complete residency in internal medicine with Loyola University Affiliated Hospitals. He then went on to complete a fellowship in rheumatology at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Brooks’s special interests include rheumatoid arhtritis; connective tissue diseases, treatment of osteoporosis and metabolic bone diseases, and clinical trials for rheumatoid arthritis and forms of inflammatory arthritis. Dr. Brooks is certified by the American Board of Internal Medicine and is a certified clinical densitometrist.

Laura Cappelli, MD, MHS

Dr. Cappelli is an Assistant Professor at the Johns Hopkins School of Medicine in the Division of Rheumatology. She received her undergraduate degree from the University of Pennsylvania and her M.D. from Johns Hopkins University School of Medicine. She completed her residency in internal medicine and performed a fellowship in rheumatology at Johns Hopkins. She also obtained an MHS in Clinical Investigation from the Johns Hopkins Bloomberg School of Public Health.

Her research focuses on the effects of cancer immunotherapy. Dr. Cappelli started a research program to evaluate the rheumatologic adverse effects of cancer immunotherapy. Rheumatologists are seeing patients with inflammatory arthritis, immune-mediated dry mouth and eyes, myositis, vasculitis and other adverse events due to these new cancer drugs. Dr. Cappelli is investigating several different aspects of these adverse events including the clinical characteristics, epidemiology, impact on patients, and the biologic mechanisms. Her work involves collaborations with oncologists and laboratory investigators in rheumatology and oncology.

Additionally, Dr. Cappelli studies rheumatoid arthritis. She has focused on defining unique clinical features of patients with seronegative disease, that is, those patients lacking the traditional markers in the blood seen in rheumatoid arthritis. She also collaborates with laboratory investigators to study the use of specific autoantibodies as biomarkers in rheumatoid arthritis.

Kevin Daley

Mr. Daley began his career in politics and government in 2010 when he managed the Chicago area for a gubernatorial election. Post-election, he spent the next six years working for the Illinois legislature and the Illinois House Republican Organization where he managed communications and outreach for several districts from across Illinois.

Mr. Daley graduated from Illinois State University where he obtained a Bachelor’s Degree in Political Science, and he is currently pursuing a MPA from the University of Illinois. Presently, Mr. Daley serves as a Manager, government relations for CSRO where he tracks and analyzes state and federal legislation that impacts rheumatologists.

Emily L. Graham, RHIA, CCS-P

Ms. Graham obtained her Bachelor of Science Degree in HIM from Stephens College. She is now Vice President of Regulatory Affairs with Hart Health Strateiges, Inc. Ms. Graham works with a broad range of clients on a variety of regulatory issues. Before her move to Hart Health Strategies Inc., Ms. Graham served as the Assistant Dean and Program Director for the Health Information Management (HIM) and Clinical Data Coding (CDC) Programs at Northern Virginia Community College’s (NVCC) Medical Education Campus (MEC).

Prior to her time in academia, Ms. Graham served as the Associate Director of Regulatory Affairs for the American Society of Cataract and Refractive Surgery (ASCRS), where she focused on a variety of regulatory issues, including Medicare physician reimbursement, Medicare’s quality improvement initiatives and advancements in health information technology. In that role she had regular dealings with representatives of the Department of Health and Human Services, to include the CMS, the ONC, and the FDA. She also served as Chair of the Quality and Health Information Technology and Regulatory Committee’s for the Alliance of Specialty Medicine and as a staff liaison to the AMA’s Current Procedural Terminology (CPT) Editorial Panel and Relative Value System Update Committee (RUC), the NQF, SQA, and AQA Alliance.

Michele Guadalupe, MPH

Ms. Guadalupe is Director of State Legislative Affairs, where she is responsible for overseeing the Arthritis Foundation’s state legislative advocacy program. She has been with the Arthritis Foundation for 12 years, first in a regional capacity in many of the Midwest and Pacific Southwest states, and most recently as State Director of Advocacy and Access. In 2016 and 2017, Ms. Guadalupe played a key role in passing step therapy legislation in Illinois, Indiana, Iowa and Missouri. Ms. Guadalupe holds an undergraduate degree in health education from Illinois State University and completed her Masters of Public Health from the University of Illinois at Chicago.

Shane Madsen, PharmD, BCPS

Dr. Madsen is the Ambulatory Clinical Pharmacy Manager at the University of Iowa Hospital & Clinics. He previously worked as a clinical pharmacy specialist in the Rheumatology Clinic as part of the UIHC Specialty Pharmacy. Dr. Madsen graduated with his Doctor of Pharmacy degree from the University of Iowa and completed his residency at the Franciscan Health System in Tacoma, Washington.

Dennis Tibben

Mr. Tibben is the Director of Government Affairs for the Iowa Medical Society. In this role, he coordinates policy development and advocacy efforts before the Iowa General Assembly, and represents IMS before a number of state boards and stakeholder health care organizations. Prior to joining the Iowa Medical Society, Mr. Tibben served as Correspondence and Judicial Appointments Coordinator in the Iowa Governor’s Office, as well as a Legislative Assistant in the Iowa Senate. Mr. Tibben received his bachelor’s degree in Political Science, with an emphasis in American Government, from Iowa State University and his Master of Public Administration, with an emphasis in Public Policy, from Drake University.

Disclosures

Relevant to the content of this educational activity, the following individuals have no conflict of interests with commercial interests to disclose.

• Kevin Daley, Speaker
• Emily L. Graham, RHIA, CCS-P, Speaker
• Michele Guadalupe, MPH, Speaker
• Shane Madsen, PharmD, BCPS, Speaker
• Liz Mathis, State Senator, Speaker
• Candance Milbourn, Planning Committee
• Pam Jochum, State Senator, Speaker
• David Staub, MD, Planning Committee
• Dennis Tibben, Speaker

Relevant to the content of this educational activity, the following individuals a conflict of interest with commercial interests to disclose.

• Michael S. Brooks, MD, FACP, FACR, Activity Director and Speaker - Receives research funding from Lilly, UCB Pfizer, Janssen, and GlaxoSmithKline.
• Laura Cappelli, MD, MHS, Speaker - Receives research funding from Bristol-Myers Squibb (nivolumab, ipilimumab). Dr. Cappelli will discuss off label use of immunosuppression to treat IRAEs, specifically TNF-inhibitors, methotrexate, tocilizumab.